Topical Gel Catches Up With Pills for Relief (NYT)

[mike r]

http://www.nytimes.com/2010/09/07/health/07pain.html

September 6, 2010
Topical Gel Catches Up With Pills for Relief
By LAURIE TARKAN

When I strained a back muscle playing tennis not long ago, my doubles partner, who happened to be a doctor, pulled a tube of cream from her gym bag and told me to rub it on. It wasn’t Bengay or one of those instant ice gels. It was a nonsteroidal anti-inflammatory drug, like Advil or Motrin, in a cream applied to the skin. She raved about the stuff, which she buys over the counter when she goes to Europe, and lamented that it is so hard to find in the United States.

In fact, Europeans have long been able to buy nonsteroidal anti-inflammatory drugs, or Nsaids (pronounced EN-seds), in gels, creams, sprays and patches to ease muscle and joint pain more directly than a pill. But in the United States, the first of these topical Nsaids was approved just three years ago, for prescription use only, with a “black box” insert warning of side effects.

“I slap it on as soon as I get an injury,” said R. Andrew Moore, a pain researcher at the University of Oxford in England who was an author of a recent analysis of studies on the use of topical Nsaids for acute injuries like sprains and strains. (Dr. Moore has received research financing from and has consulted for drug companies in the past.) At first, he said, the researchers were skeptical of the drugs. Older studies had been poorly designed or too brief, and there has been little evidence of effectiveness for other types of medicated creams or those containing the chili pepper component capsaicin.

But a number of new controlled trials and meta-analyses like Dr. Moore’s suggest that topical Nsaids are as effective as their oral counterparts for treating osteoarthritis in the knee and hand as well as musculoskeletal injuries like soreness and tendinitis. The main advantage of a skin cream is that it bypasses the stomach and much of the bloodstream, theoretically minimizing serious side effects. Oral Nsaids can be toxic to the kidneys, and they increase the risk of gastrointestinal bleeding. And some, including Vioxx and Bextra, were taken off the market after they were linked to heart attacks and strokes. “The turning point for topical Nsaids was the fright over heart problems with Vioxx,” Dr. Moore said. “Suddenly there were tons of folks who thought topical Nsaids were a good idea.”...

[BeFree]

1. Works for me

[Mimosa]

2. "for prescription use only"...there's the rub.

Europeans can buy over the counter what we need an expensive Dr's visit to get. And I bet the Rx gels are expensive.

[tridim]

3. What about Aspercream?

[unblock]

4. i thought all salicylates were nsaids

in which case bengay and aspercream would be in this category.